Speaking of legacy: Toward an ethos of modesty at the international criminal tribunal for Rwanda

Pour qu’un héritage soit réellement grand, il faut que la main du défunt ne se voie pas.In 2014, a year of memorial ceremonies commemorating the twentieth anniversary of the Rwandan genocide, the International Criminal Tribunal for Rwanda (ICTR) marked its own twentieth year with the launch of a “legacy website.” With the closing of the Tribunal scheduled for December 2015, the question of its legacy had become increasingly pressing. The website premiered a video that “celebrates the accomplishments of the ICTR” in a “visually compelling” style. Blurring the distinction between documentary account and film trailer, the video begins with iconic images of the African continent: a boy rolling a hoop down a dirt road; laborers ferrying wares; women in colorful dresses tending children. These scenes of daily life are interrupted by images of men wielding machetes and corpses, interspersed with the figure of the radio, reminding the viewer that the 1994 genocide was encouraged through broadcasts inciting Hutus to take up arms against their Tutsi neighbors. The video lists the Tribunal’s contributions to international criminal law, but also describes a much broader impact: “a record of legal reform in Rwanda, and outreach, education, legal training, and healing.” Young boys leap into a body of water to punctuate the final term, suggesting the hope of a new Rwanda. The narrator proclaims, “today in Rwanda, it’s safe to listen to the radio again: the sound is of a nation rebuilding.” The film’s final words reach beyond the Rwandan context, affirming that ours is “a world pushing forward despite great imperfection, each day closer to a time when international law offers justice to all people, everywhere.”Economic and Social Research Council (Grant ID: ES/L010976/1)This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by American Society of International Law

Spousal support and relationship happiness in adults with type 2 diabetes and their spouses

Objectives The purpose of this study was to examine the association between the perceptions of spousal support self-efficacy in terms of dietary self-care and relationship happiness. Methods Forty-six couples, in which only one spouse has type 2 diabetes, completed questionnaires on perceptions of spousal support self-efficacy and relationship happiness. Results Using an actor-partner interdependence model, we found that when persons with type 2 diabetes were more confident in their spouse’s ability to provide them with support regarding their dietary self-care, they reported more relationship happiness. We also found that when their spouse without diabetes was more confident in their own abilities to provide such support to their partner, they reported more relationship happiness. However, the person with diabetes’ confidence in their spouse’s support abilities and the spouse’s confidence in their own support abilities were not associated with the other partner’s relationship happiness. Conclusions This study offers a unique dyadic perspective on the determinants of happiness for couples in which one spouse has type 2 diabetes. The perceived quality of spousal support appears to be associated with relationship happiness in committed couples managing diabetes, regardless of the actual support received or provided

The role of working memory sub-components in food choice and dieting success

Evidence suggests a role for self-reported working memory (WM) in self-reported food intake, but it is not known which WM sub-components are involved. It is also important to consider how individual differences in dietary restraint and disinhibition influence WM and the impact of this on food choice. The current study assessed the relationship between WM sub-components and food choice, using computerised measures of WM sub-components and a direct assessment of food intake. The role of dieting success (measured by restraint and disinhibition) as a distal predictor of food choice that influences food choices via WM, and the role of WM more generally in dieting success were investigated. Female undergraduate students (N = 117, mean age: 18.9 years, mean BMI: 21.6 kg/m2) completed computer tasks assessing three components of WM (updating, phonological loop and visuospatial sketchpad) and a snack food taste-test. Greater visuospatial WM span was associated with a higher (lower) percentage of food intake that was low (high) energy dense. It was also found that unsuccessful dieters (high restraint, high disinhibition) had poorer visuospatial WM span and consumed a lower (higher) percentage of low (high) energy dense food. Visuospatial WM span significantly mediated the relationship between dieting success and percentage of low energy dense food intake. Further, dietary restraint was associated with poorer updating ability, irrespective of disinhibition. These findings suggest that better visuospatial WM is associated with a greater (reduced) preference for low (high) energy dense foods, and that deficits in visuospatial WM may undermine dieting attempts. Future work should assess whether the ability to deal with food cravings mediates the relationship between visuospatial WM and dieting success and investigate how WM may influence the mechanisms underlying behavioural control

Diabetes distress, depressive, and anxiety symptoms in people with type 2 diabetes: a network analysis approach to understanding comorbidity

Objective This study aimed to explore interactions between diabetes distress, depressive, and anxiety symptoms in a cohort of adults with type 2 diabetes using network analysis. Research design and methods Participants (N = 1,796) were from the Evaluation of Diabetes Insulin Treatment (EDIT) study from Quebec, Canada. A network of diabetes distress symptoms was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the 17 items of the DDS-17, the 9 depressive items of the Patient Health Questionnaire (PHQ-9), and the 7 anxiety items of the Generalized Anxiety Disorder Assessment (GAD-7). Network analysis was used to identify central symptoms, clusters of symptoms, and symptoms that may bridge between diabetes distress, depressive, and anxiety symptoms. Results Regimen-related and physician-related diabetes distress symptoms were amongst the most influential (most positive connections to others) in the diabetes distress network. Feeling like a failure (depression) was identified as a potential bridge between depression and diabetes distress, being highly connected to symptoms of diabetes distress. The anxiety symptoms of worrying too much and being unable to stop worrying were found to be bridge symptoms between both anxiety and depression symptoms, and anxiety and diabetes distress symptoms, respectively. Conclusions These findings suggest individual symptoms that might be influential to the development and maintenance of diabetes distress and mental health comorbidity in diabetes and warrant further investigation. Study limitations and potential for clinical applicability are discussed

The mediating role of comorbid conditions in the association between type 2 diabetes and cognition: a cross-sectional observational study using the UK Biobank cohort

Aims: Using the UK Biobank cohort, a large sample of middle aged and older adults in the UK, the present study aimed to examine the cross-sectional association between type 2 diabetes and cognition and to assess the hypothesised mediating role of common comorbid conditions, whilst controlling for important demographic and lifestyle factors. Methods: Using regression models and general structural equation models, we examined the cross-sectional association between type 2 diabetes status and: fluid intelligence; reaction time; visual memory; digit span and prospective memory; and the hypothesised mediating role of common comorbid conditions: visceral obesity; sleep problems; macrovascular problems; respiratory problems,; cancer and depressive symptoms in 47,468 participants from the UK Biobank cohort, of whom 1,831 have type 2 diabetes. We controlled for ethnicity, sex, age, deprivation, smoking status, alcohol consumption, physical activity levels and use of diabetes medication. Results: Participants with type 2 diabetes had a significantly shorter digit span, b = -0.14, 99.2% CIs [-0.27, -0.11] than those without type 2 diabetes. Those with type 2 diabetes did not differ from those without type 2 diabetes on fluid intelligence, reaction time, visual memory and prospective memory. The associations that do exist between type 2 diabetes and cognition are consistently mediated via macrovascular problems, depressive symptoms, and to a lesser extent visceral obesity. Respiratory problems, sleep disturbances and cancer did not mediate the association between type 2 diabetes status and measures of cognition. Conclusions: Comorbid conditions explain some of the observed association between type 2 diabetes and cognitive deficits. This suggests that prevention, management or treatment of these comorbid conditions may be important to reduce the likelihood of cognitive decline. Treatment studies with long follow-ups are needed to examine this. Tweet: Comorbid conditions explain the association between type 2 diabetes and cognitive deficits. Prevention, management or treatment of these comorbid conditions may prevent or delay the onset of cognitive decline in people with type 2 diabetes

Prediabetes and the risk of type 2 diabetes: investigating the roles of depressive and anxiety symptoms in the Lifelines Cohort Study

Background Depression and anxiety may increase the risk of progressing from prediabetes to type 2 diabetes. The present study examined the interactions between prediabetes status and elevated depressive and anxiety symptoms with the risk of type 2 diabetes. Methods Participants (N=72,428) were adults aged 40 years and above without diabetes at baseline from the Lifelines Cohort Study (58% female; mean age=51.4 years). The Mini-International Neuropsychiatric Interview screened for elevated symptoms of major depressive disorder and generalized anxiety disorder. Glycated hemoglobin A1c (HbA1c) levels determined prediabetes status at baseline (2007-2013), and HbA1c and self-reported diabetes diagnoses determined diabetes status at follow-up (2014-2017). Groups were formed for elevated depressive and anxiety symptoms, respectively, and prediabetes status at baseline (elevated depressive/anxiety symptoms with prediabetes, elevated depressive/anxiety symptoms alone, and prediabetes alone), and compared to a reference group (no prediabetes or anxiety/depression) on the likelihood of developing diabetes during the follow-up period. Findings N=1,300 (1.8%) participants developed diabetes. While prediabetes alone was associated with incident diabetes (OR=5.94; 95% CI=5.10-6.90, p<.001), the group with combined prediabetes and depressive symptoms had the highest likelihood of developing diabetes over follow-up (OR=8.29; 95% CI=5.58-12.32, p<.001). Similar results were found for prediabetes and anxiety symptoms (OR=6.57; 95% CI=4.62-9.33, p<.001), compared to prediabetes alone (OR=6.09; 95% CI=5.23-7.11, p<.001), though with a smaller effect. The interaction between depressive symptoms and prediabetes was synergistic in age-and-sex adjusted analyses. Conclusion Individuals with elevated depressive, and to some extent anxiety, symptoms in combination with prediabetes may represent a high-risk subgroup for type 2 diabetes

Does neurocognitive training have the potential to improve dietary self-care in type 2 diabetes? Study protocol of a double blind randomised controlled trial

Dietary self-care is a key element of self-management in type 2 diabetes. It is also the most difficult aspect of diabetes self-management. Adhering to long-term dietary goals and resisting immediate food desires requires top-down inhibitory control over subcortical impulsive and emotional responses to food. Practising simple neurocognitive tasks can improve inhibitory control and health behaviours that depend on inhibitory control, such as resisting alcohol consumption. It is yet to be investigated, however, whether neurocognitive training can improve dietary self-care in people with type 2 diabetes. The aim of this randomised controlled trial is to investigate whether web-based neurocognitive training can improve the ability of people with type 2 diabetes to resist tempting foods and better adhere to a healthy dietary regime

Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EHMS and UK Biobank datasets

Background: The prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but measurement invariance of the PHQ-9 across groups of people with and without diabetes has not yet been investigated. Methods: Data from three independent cohorts from the USA (n=1,886 with diabetes, n=4,153 without diabetes), Quebec, Canada (n= 800 with diabetes, n= 2,411 without diabetes), and the UK (n=4,981 with diabetes, n=145,570 without diabetes), were used to examine measurement invariance between adults with and without diabetes. A series of multiple group confirmatory factor analyses were performed, with increasingly stringent model constraints applied to assess configural, equal thresholds, and equal thresholds and loadings invariance, respectively. One-factor and two-factor (somatic and cognitive-affective items) models were examined. Results: Results demonstrated that the most stringent models, testing equal loadings and thresholds, had satisfactory model fit in the three cohorts for one-factor models (RMSEA = .063 or below and CFI = .978 or above) and two-factor models (RMSEA = .042 or below and CFI = .989 or above). Limitations: Data were from Western countries only and we could not distinguish between type of diabetes. Conclusions: Results provide support for measurement invariance between groups of people with and without diabetes, using either a one-factor or a two-factor model. While the two-factor solution has a slightly better fit, the one-factor solution is more parsimonious. Depending on research or clinical needs, both factor structures can be used

Self-Monitoring of Blood Pressure in Hypertension: A UK Primary Care Survey

This study aimed to determine the prevalence of Self-Monitoring Blood Pressure amongst people with hypertension using a cross-sectional survey. Of the 955 who replied (53%), 293 (31%) reported that they self-monitored blood pressure. Nearly 60% (198/331) self-monitored at least monthly. Diabetic patients monitoring their blood glucose were five times more likely than those not monitoring to monitor their blood pressure. Self-monitoring is less common in the UK than internationally, but is practiced by enough people to warrant greater integration into clinical practice

Relationship between parental feeding practices and neural responses to food cues in adolescents

Social context, specifically within the family, influences adolescent eating behaviours and thus their health. Little is known about the specific mechanisms underlying the effects of parental feeding practices on eating. We explored relationships between parental feeding practices and adolescent eating habits and brain activity in response to viewing food images. Fifty- seven adolescents (15 with type 2 diabetes mellitus, 21 obese and 21 healthy weight controls) underwent fMRI scanning whilst viewing images of food or matched control images. Participants completed the Kids Child Feeding Questionnaire, the Childrens’ Dutch Eating Behaviour Questionnaire (DEBQ) and took part in an observed meal. Parents completed the Comprehensive Feeding Practices Questionniare and the DEBQ. We were particularly interested in brain activity in response to food cues that was modulated by different feeding and eating styles. Healthy-weight participants increased activation (compared to the other groups) to food in proportion to the level of parental restriction in visual areas of the brain such as right lateral occipital cortex (LOC), right temporal occipital cortex, left occipital fusiform gyrus, left lateral and superior LOC. Adolescents with type 2 diabetes mellitus had higher activation (compared to the other groups) with increased parental restrictive feeding in areas relating to emotional control, attention and decision-making, such as posterior cingulate, precuneus, frontal operculum and right middle frontal gyrus. Participants with type 2 diabetes mellitus also showed higher activation (compared to the other groups) in the left anterior intraparietal sulcus and angular gyrus when they also reported higher self restraint. Parental restriction did not modulate food responses in obese participants, but there was increased activity in visual (visual cortex, left LOC, left occipital fusiform gyrus) and reward related brain areas (thalamus and parietal operculum) in response to parental teaching and modelling of behaviour. Parental restrictive feeding and parental teaching and modelling affected neural responses to food cues in different ways, depending on motivations and diagnoses, illustrating a social influence on neural responses to food cues